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expert reaction to study looking at measures of hostility and recurrence of disease and death in people with acute coronary syndrome

A study, published in the European Journal of Cardiovascular Nursing, looked at measures of hostility and recurrence of disease and death in people with acute coronary syndrome.


Prof Tim Chico, Professor of Cardiovascular Medicine and Honorary Consultant Cardiologist, University of Sheffield, said:

“This study showed that heart attack patients who scored highly for hostility were slightly more likely to die within two years of a heart attack than those who were not hostile.  The actual difference was small and there are many possible explanations for this such as hostile patients being less likely to alter their lifestyles or take preventative medications, both of which are powerful ways to reduce future risk (and should be combined for maximum effectiveness).  It is too early to suggest that interventions that reduce hostility would improve death rates in heart attack sufferers.  Unfortunately, heart disease is associated with many factors that are not the cause of the disease itself, and this study cannot prove that hostility is a direct cause of heart disease.”

“I find some of the data hard to reconcile, as the overall death rate was 1.6%, but figure 2 shows all cause survival in the hostile group to fall to around 97%, and in the non-hostile group to fall to less than 98.5%, which on the face of it is inconsistent.”


Prof Sian Harding, Professor of Cardiac Pharmacology, Imperial College London, said:

“This adds to a body of knowledge which links strong (mostly negative) emotion with cardiac death (often arrhythmic sudden cardiac death).  It is well powered and has a useful message for cardiac patients.  A surprisingly large proportion of the cardiac patients scored highly on the hostility score, which increases its relevance.”


‘Hostility predicts mortality but not recurrent acute coronary syndrome’ by Tracey K Vitori et al. was published in the European Journal of Cardiovascular Nursing at 00:15 UK time on Tuesday 15 September 2020.

DOI: 10.1177/1474515120950913


Declared interests

Prof Tim Chico: “No conflicts.”

None others received.

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